| NPI | 1285014159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: NJ 25MA10959600) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: NY 306126) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2024-08-06 |